525993

research-articleXXXX
CANXXX10.1177/1941406414525993Infant, Child, & Adolescent NutritionInfant, Child, & Adolescent Nutrition

ICAN: Infant, Child, & Adolescent Nutrition June 2014

Adolescents

Nutrient Inadequacy Is Prevalent in

Pregnant Adolescents, and Prenatal
Supplement Use May Not Fully
Compensate for Dietary Deficiencies
Sunmin Lee, MS, RD, Bridget E. Young, PhD, CLC, Elizabeth M. Cooper, CNM, EdD, FACNM, Eva Pressman, MD,
Ruth Anne Queenan, MD, MBA, Christine M. Olson, PhD, Ronnie Guillet, MD, PhD, and Kimberly O. O’Brien, PhD

Abstract: A longitudinal study of dietary inadequacy for many issues of concern for this group include
was undertaken in 156 pregnant nutrients but may not be sufficient to inadequate gestational weight gain
adolescents (≤18 years old) to meet the requirements for Mg and Ca. (GWG) and increased risks of
characterize dietary intake and to Practitioners should identify motivators preeclampsia, anemia, sexually
determine the degree to which prenatal and barriers to adequate diet and transmitted diseases, fetal death in utero,
supplement use compensates for dietary prenatal supplement use in order to preterm delivery (<37 weeks’ gestation),
deficits. The adequacy of dietary address key nutrients of concern. and low birth weight (LBW; <2500 g).2,3
intake was assessed by comparing
self-reported intake from up to three
24-hour dietary recalls with the dietary “Because diet is a modifiable lifestyle factor that can
reference intakes. The majority of teens
did not meet the estimated average be used to improve birth outcomes, targeted
requirements (EAR) for vitamin D screening and assessment in pregnant adolescents
(93%), vitamin E (94%), Mg (90%),
Fe (76%), and Ca (74%). More is essential when designing interventions to
than half of the adolescents in each
gestational window (<23 weeks; 23-30 promote optimal pregnancy outcomes.”
weeks; and ≥31 weeks of gestation)
self-reported daily use of prenatal
supplements, but the additional Keywords: pregnancy; adolescents; Late entry into prenatal care,
supplement contributions were not dietary intake; supplements; estimated sociodemographic and lifestyle factors
sufficient to meet the EAR for Mg (90%) average requirements (poverty, unmarried marital status, low
or Ca (54%). Pregnant adolescents educational levels, smoking, and drug
are at risk for insufficient intake of use), and physiological factors
Introduction
several essential nutrients from diet (gynecological immaturity and
alone in spite of adequate or excessive In 2011, the birth rate of babies born to competition for nutrients between the
energy intakes. Daily use of prenatal US teens (15-19 years old) was 31.3 per mother and the fetus) have been
supplements reduces the prevalence 1000.1 Previously recognized health associated with restricted fetal growth

DOI: 10.1177/1941406414525993. From the Division of Nutritional Sciences, Cornell University, Ithaca, New York (SL, BEY, CMO, KOO); and University of Rochester School
of Medicine and Dentistry, Rochester, New York (EMC, EP, RAQ, RG). Address correspondence to Kimberly O. O’Brien, PhD, Division of Nutritional Sciences, Cornell University,
230 Savage Hall, Ithaca, NY 14853; e-mail: koo4@cornell.edu.
For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
Copyright © 2014 The Author(s)

152
vol. 6 • no. 3 ICAN: Infant, Child, & Adolescent Nutrition
and increased risk of LBW in this age
group.3
Poor-quality diets have also been
linked to adverse birth outcomes. Fe
deficiency has been associated with
increased risk of preterm birth and
LBW4,5; increased sugar intake has been
associated with LBW and small-for-
gestational age (SGA) deliveries6; and
folate deficiency has been associated
with increased risk of preterm birth and
LBW.7 Because diet is a modifiable
lifestyle factor that can be used to
improve birth outcomes, targeted
screening and assessment in pregnant
adolescents is essential when designing
interventions to promote optimal
pregnancy outcomes. Although meeting
the nutrient needs through a healthy diet
alone is optimal, many adolescents fail to
achieve the dietary reference intake
(DRI) for key nutrients during pregnancy.
Data from the 1999 to 2004 NHANES
(National Health and Nutrition
Examination Survey) found that children
and adolescents with healthier nutrition,
more active lifestyles, greater food
security, and greater health care access
were more likely to use vitamin and
mineral supplements.8 However, limited
descriptive data on dietary intake are
available in adolescent cohorts, and even
less is known about prenatal supplement
use among pregnant adolescents. This
study was undertaken to (1) examine
dietary intake and the prevalence of
inadequate intake of key nutrients across
pregnancy and (2) assess supplement
use in this group and the degree to
which prenatal supplements helped
bridge gaps for nutrients of concern.
Participants and Methods
Pregnant adolescents receiving prenatal
care at the Rochester Adolescent
Maternity Program (RAMP) in Rochester
NY were recruited between 2006 and
2009 (n = 156). Adolescents who were
≤18 years old, carrying a single fetus, 12
to 30 weeks of gestation at entry into the
study, and otherwise healthy were
eligible to participate. Written informed
consent was obtained and assent (for
those 13-14 years old), and the study was
approved by the institutional review
boards of the University of Rochester and
Cornell University. Teens attended up to
3 study visits across pregnancy, and
24-hour dietary recalls were administered
by a single health project coordinator
who was trained in conducting diet
recalls by the research dietitians at the
University of Rochester’s Clinical and
Translational Science Center. Brand
names of foods were recorded, so that
nutrient composition could be more
accurately analyzed in the database.
Dietary recall data were entered into the
Nutrient Data System for Research
(versions 2006, 2008, and 2009, Nutrition
Coordinating Center, University of
Minnesota, Minneapolis, MN) and
analyzed by a registered dietitian at the
University of Rochester Clinical and
Translational Science Center.
Contributions from supplemental
vitamins were not included in the dietary
recall nutrient calculations.
Macronutrient intakes were compared
with the acceptable macronutrient
distribution range. Currently there is no
DRI for saturated fat intake; thus,
saturated fat intake was compared with
the 2010 Dietary Guidelines for
Americans (<10% of total caloric intake).9
The prevalence of inadequate intake of
vitamins and minerals was calculated as
the proportion of individuals whose
intakes were below the estimated
average requirement (EAR), which
represents the amount of nutrient
estimated to meet the requirements of
half the healthy people in a particular
life stage and gender group, and
estimates the prevalence of inadequacy
for groups.10 Dietary data were grouped
into 3 gestational windows (GWs)—<23
weeks, 23-30 weeks, and ≥31 weeks of
gestation—to characterize dietary intake
across gestation. If multiple recalls were
collected within the same GW from the
same person (n = 60), average intake
values were used for analyses.
All pregnant teens attending RAMP
were prescribed a standard prenatal
supplement containing the following:
vitamin A (1200 µg), vitamin C (120 mg),
vitamin D3 (10 µg), vitamin E (22 mg),
thiamin (1.84 mg), riboflavin (3 mg),
niacin (20 mg), vitamin B6 (10 mg),
vitamin B12 (12 µg), folic acid (1000 µg),
Ca (200 mg), Fe (27 mg), Zn (25 mg),
and Cu (2000 µg). If the adolescent
reported intolerance to or had difficulty
with this supplement, a pediatric
supplement was recommended, of which
teens were advised to consume 2 pills
per day to account for their 25% to 50%
lower nutritional content.
Data Analysis
Distributions of nutrients were
evaluated, and descriptive statistics of
nutrients were calculated. Two sample t
tests and 1-way ANOVA with Bonferroni
correction for multiple testing were used
to test for differences in mean nutrient
intake as a function of age group, race,
ethnicity, and GWs. Nonnormally
distributed variables were log-
transformed to achieve normality. The
level of significance was set at P < .05.
All analyses were performed using SAS
(version 9.2, 2008, SAS Institute Inc, Cary,
NC) and JMP (version 8, 2011, SAS
Institute Inc, Cary, NC).
Results
Table 1 presents the sociodemographic
characteristics of the teen mothers who
provided at least 1 dietary recall. Among
the teen mothers, 72% (n = 112) were
enrolled in the Supplemental Nutrition
Program for Women, Infants and Children.
Current use of cigarettes or alcohol were
reported by 11% (n = 17) and 32% (n =
50) of adolescents, respectively. The
average GWG of the overweight (19.7 ±
9.8 kg) and obese teens (15.1 ± 7.6 kg)
exceeded Institute of Medicine
guidelines.11 Among the 156 teens, 8 (5%),
37 (24%), and 109 (70%) teens provided
1, 2, or 3 dietary recalls across gestation,
respectively. Mean dietary intake in each
GW and overall intake across pregnancy
are presented in Table 2. Diet recalls were
not collected from 62 teens during the
<23 weeks GW, 33 teens during the 23 to
30 weeks GW, and 23 adolescents at ≥31
weeks of gestation. Caloric intake from
carbohydrate and protein were within the
acceptable macronutrient distribution
ranges, but the percentage of energy
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 ICAN: Infant, Child, & Adolescent Nutrition June 2014
Table 1.
Characteristics of Pregnant Adolescents (n = 156).
Mean ± SD
Age
Race
  African American
 Caucasians
  American Indian
Ethnicity
 Hispanic
 Non-Hispanic
Prepregnancy BMIa (kg/m2)
  <18.5 (Underweight)
  18.5-24.99 (Normal)
  25.0-29.99 (Overweight)
  ≥30.00 (Obese)
Gestational weight gain (kg)
 <Recommended
 Recommended
 >Recommended
Abbreviations: SD, standard deviation; BMI, body mass index.
a
World Health Organization BMI categories.
obtained from fat (36%) exceeded
recommended levels (20%-35%) in every
GW. Also, 79% of teens exceeded the
recommended intake level for saturated
fat (≥10% of total caloric intake), and
one-third consumed more than 20% of
their daily energy intake from added
sugar. No significant differences were
found in the mean nutrient intakes across
the 3 GWs except for vitamin D and
niacin. A substantial proportion of teens
(Table 3) had inadequate intakes for
vitamin D (92%), vitamin E (94%), and Mg
(89%), followed by Fe (76%) and Ca
(74%). No significant differences were
observed as a function of maternal race,
ethnicity, or age group for any of the
nutrients examined.
154
Percentage (n)
17.1 ± 1.1  
 
64 (100)
35 (54)
1 (2)
25 (39)
75 (117)
24.7 ± 5.4  
6 (10)
56 (86)
20 (30)
18 (28)
17.0 ± 8.0  
18 (26)
24 (36)
58 (86)
More than half of the adolescents
surveyed in each GW stated that they
took their prenatal supplement on a
daily basis (Table 4). To assess the
relative contribution from the
supplement, the nutrient content of the
prenatal supplement was added to the
average dietary intake of nutrients with
the highest prevalence of inadequacy
(Table 5). The amount of Fe, vitamin E,
and vitamin D in prenatal or pediatric
supplements exceeded the EAR; thus,
intake of these nutrients would meet the
EAR if supplements were consumed. For
Ca, if adolescents took their prenatal
supplements on a daily basis, an
approximate 21% drop (74% to 53%) was
observed in the prevalence of
inadequacy after accounting for either
type of supplement. For Mg, an
approximate 8% drop (90% to 82%) in
the prevalence of inadequacy would
occur, but only if pediatric chewable
supplements were used because the
standard prenatal supplement prescribed
did not contain Mg.
Discussion
In the present study, suboptimal dietary
intakes of a number of micronutrients
were observed in spite of sufficient or
excessive energy intakes and excessive
GWG. These findings are indicative of a
diet comprising high-calorie/low–
nutrient-dense foods (high-sugar snacks,
fast-food, and convenience foods). This
is not uncommon in adolescents who
may find healthy eating challenging
because of a lack of financial resources
and who may have less self-efficacy with
respect to purchasing and preparing
healthy meals.12 A previous study in teen
mothers found that those who consumed
high-sugar diets (daily total sugar intake
≥206 g, corresponding to ≥90th
percentile) were 3.4 times more likely to
deliver a SGA infant.13 The fact that the
90th percentile of total sugar intake
among our teen cohort (222 g) exceeded
this value is of concern and reaffirms the
need for early dietary assessment and
interventions to minimize high sugar
intakes in this age group.
Our data provide insight into several
nutrients of concern and the degree to
which daily prenatal supplements helped
reduce nutritional deficits. Suboptimal
intakes for Mg, Fe, Ca, vitamin E, and
vitamin D were found in >70% of these
teens, with the highest rate of dietary
inadequacy for Ca and Mg, even after
accounting for the amount contained in a
daily prenatal supplement, if consumed.
During pregnancy, approximately 25 to
30 g of Ca are transferred into the fetal
skeleton, most of which is accrued
during the last trimester of pregnancy.14
We recently reported that maternal Ca
intakes >1050 mg/d were positively
associated with fetal femur and humerus
Z-scores and birth length in these
teens.15 Mean Ca intake was far below
vol. 6 • no. 3 ICAN: Infant, Child, & Adolescent Nutrition

Table 2.
Dietary Intake of Pregnant Adolescents.a

AMDR/ <23 Weeks’ 23-30 Weeks’ ≥31 Weeks’ Mean Over

EARb Gestation, n = 94 Gestation, n = 123 Gestation, n = 133 Pregnancy, n = 156
Average week of gestation 18.4 ± 2.7 27.0 ± 1.8 34.4 ± 2.1 27.5 ± 6.7
Calories (kcal) 2222.1 ± 871.5 2299.9 ± 914.2 2303.2 ± 838.6 2273.0 ± 674.0
Carbohydrate (g) 45%-65% 289 ± 127.1 305.4 ± 132.1 291.1 ± 118.2 295.0 ± 99.1
Fat (g) 20%-35% 88.6 ± 40.2 88.7 ± 42.3 93.2 ± 42.8 90.2 ± 31.3
Protein (g) 10%-35% 73.8 ± 26 76.1 ± 34.6 81.3 ± 33.5 70.1 ± 31.4
Added sugar (g) 88.6 ± 58.8 102.6 ± 62.4 98.2 ± 60.5 97.4 ± 48.5

Fiber (g) 26.0 13.6 ± 6.9 13.4 ± 6.8 13.1 ± 7.4 13.6 ± 5.2
Vitamin Ac (µg) 530 625.6 ± 441.4 608.9 ± 414.5 698.4 ± 498.6 666.2 ± 325.5
d ,† †
Vitamin D (µg) 10.0 4.56 ± 3.6* 4.7 ± 4.6* 5.4 ± 4.0 5.1 ± 3.2
Vitamin Ee (mg) 12.0 6.2 ± 3.5 6.5 ± 3.8 6.9 ± 4.1 6.9 ± 3.3
Vitamin K (µg) 75.0 56.3 ± 40.4 70.4 ± 104.1 70.0 ± 79.0 70.1 ± 68.8
Vitamin C (mg) 66.0 114.0 ± 107.0 109.6 ± 104.5 97.2 ± 94.5 105.9 ± 78.8
Thiamin (mg) 1.2 1.9 ± 1.0 2.1 ± 1.1 2.1 ± 1.0 2.1 ± 1.0
Riboflavin (mg) 1.2 2.2 ± 1.0 2.4 ± 1.6 2.5 ± 1.1 2.4 ± 1.2
Niacinf (mg) 14.0 23.5 ± 11.6* 24.4 ± 13.3*,† 28.0 ± 11.56† 25.5 ± 11.5
Vitamin B6 (mg) 1.6 1.9 ± 1.0 2.0 ± 1.4 2.2 ± 1.0 2.1 ± 1.2
Vitamin B12 (µg) 2.2 5.0 ± 3.1 4.4 ± 3.8 5.6 ± 3.7 5.5 ± 2.9
g
Folate (μg)  520 705.3 ± 461.6 863.2 ± 1492.5 828.7 ± 623.8 849.1 ± 1301.1
Fe (mg) 23.0 17.1 ± 9.8 18.3 ± 12.0 18.8 ± 9.7 18.6 ± 9.9
Cu (µg)  785 1100.0 ± 500.0 1100.0 ± 600.0 1100.0 ± 500.0 1085.9 ± 414.2
Zn (mg) 10.5 11.2 ± 5.2 12.6 ± 9.6 12.8 ± 6.4 12.6 ± 7.8
Mg (mg)  335 224.1 ± 90.4 226.3 ± 101.2 237.2 ± 90.9 230.9 ± 82.8
P (mg) 1055 1131.1 ± 443.2 1184.5 ± 563.7 1264.4 ± 487.7 1196.1 ± 413.4
Ca (mg) 1100 846.2 ± 442.4 886.3 ± 568.0 916.4 ± 463.9 886.2 ± 393.3

Abbreviations: AMDR, acceptable macronutrient distribution range; EAR, estimated average requirements.
a
Data are expressed as mean ± SD. Values within a column not sharing similar symbols (asterisk and dagger) are significantly different (P < .05). Diet
recalls were not collected from 62 (<23 weeks), 33 (23-30 weeks), and 23 adolescents (≥31 weeks gestational window).
b
AMDR/EAR for pregnancy in those 14 to 18 years old. AMDR for carbohydrate, fat, and protein are expressed as percentage of total caloric intake.
c
As retinol activity equivalents (RAEs). 1 RAE = 1 μg retinol, 12 μg β-carotene, 24 μg α-carotene, or 24 μg β-cryptoxanthin.
d
As cholecalciferol; 1 µg cholecalciferol = 40 IU vitamin D.
e
As α-tocopherol.
f
As niacin equivalents (NE). 1 mg of niacin = 60 mg of tryptophan.
g
As dietary folate equivalents (DFE). 1 DFE = 1 μg food folate = 0.6 μg of folic acid from fortified food or as a supplement consumed with food.

this value, and 74% of teens did not products, especially if displaced by to overcome dietary deficits; thus,
achieve the EAR from diet, which may be sweetened beverages. Many prenatal encouraging intake of dairy products and
related to limited consumption of dairy supplements do not contain enough Ca Ca-fortified foods may assist in meeting

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 ICAN: Infant, Child, & Adolescent Nutrition June 2014

Table 3.
Percentage of Study Population Ingesting Inadequate Dietary Intakes of Selected Nutrients.a

<23 Weeks’ 23-30 Weeks’ ≥31 Weeks’ Mean Over

Gestation, n = 94 Gestation, n = 123 Gestation, n = 133 Pregnancy, n = 156
Average week of gestation 18.4 ± 2.7 27.0 ± 1.8 34.4 ± 2.1 27.5 ± 6.7
Carbohydrate (g) 19 19.5 27.8 17
Fat (g)  2  5.6 4  1.3
Saturated fat (g) 23.4 29.3 31 21
Protein (g)  7.4 16.3 13.5 6.4
Vitamin Ab (μg) 52 52 45.1 38.9
c
Vitamin D (µg) 90.4 90 90.2 92.4
Vitamin Ed (mg) 94.7 93.3 87.5 93.6
Vitamin C (mg) 40 47 52 40
Thiamin (mg) 21.3 20 18 13.4
Riboflavin (mg) 10.6 17.5 14.1 8.9
e
Niacin (mg) 18 20 11 9.6
Vitamin B6 (mg) 43 40.8 29.7 33.1
Vitamin B12 (µg) 16 25 12.5 11.5
Folatef (μg) 36 38.2 39.1 30.6
Fe (mg) 81 75 72.7 76.4
Cu (µg) 31 27.5 22.7 23.6
Zn(mg) 51 46.7 41.4 38.2
Mg (mg) 87 85.8 86 89.8
P (mg) 51.1 49.2 36 39.5
Ca (mg) 71.2 70 70 73.9
a
Data are expressed as the percentage of pregnant adolescents studied who did not meet the acceptable macronutrient distribution ranges/estimated
average requirements for pregnancy in those 14 to 18 years old. Diet recalls were not collected from 62 (<23 weeks), 33 (23-30 weeks), and 23 adoles-
cents (≥31 weeks gestational window).
b
As retinol activity equivalents (RAEs). 1 RAE = 1 μg retinol, 12 μg β-carotene, 24 μg α-carotene, or 24 μg β-cryptoxanthin.
c
As cholecalciferol; 1 µg cholecalciferol = 40 IU vitamin D.
d
As α-tocopherol.
e
As niacin equivalents (NE). 1 mg of niacin = 60 mg of tryptophan.
f
As dietary folate equivalents (DFE). 1 DFE = 1 μg food folate = 0.6 μg of folic acid from fortified food or as a supplement consumed with food.

the Ca demands. Dietary Mg inadequacy
has been found to be associated with an
increased risk of miscarriage, fetal
growth retardation, maternal
hospitalizations, and preterm delivery.16
Most prenatal supplements contain only
10% to 25% of the RDA for Mg, and
some do not contain any Mg; thus,
emphasis should be put on consuming
additional dietary sources of Mg.
Meeting nutrient requirements from a
healthy diet is optimal but may be
challenging when dietary quality is poor
or when requirements increase as a
result of pregnancy. Prenatal
supplements are particularly useful in
bridging gaps and can reduce the risk of
adverse birth outcomes. A large cohort
study in low-income, pregnant urban
women and adolescents (n = 1430)
showed a 2- to 4-fold diminished risk of

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vol. 6 • no. 3 ICAN: Infant, Child, & Adolescent Nutrition

Table 4.
Self-reported Frequency of Supplement Use.

<23 Weeks’ Gestation, 23-30 Weeks’ Gestation, ≥31 Weeks’ Gestation,

n = 94 n = 123 n = 133
Average week of gestation 18.4 ± 2.7 27.0 ± 1.8 34.4 ± 2.1
Daily (%) 55.3 59.3 56.4
2-5 Times/wk (%) 19.1 15.4 15.8
Once a week (%) 4.3 5.7 3
Occasionally (%) 3.2 1.6 0.8
Rarely (%) 3.2 2.4 3
Never (%) 8.5 10.6 13.5
Not reported (%) 4.3 1.6 2.3

Table 5.
Total Intake and Percentage of Pregnant Adolescents Not Meeting the EAR From Combined Intake of Both Diet and Daily
Supplement Prescribed.

Prenatal Supplementb Pediatric Supplementc

Combined Intake Percentage Combined Intake Percentage
from Diet and Not Achieving from Diet and Not Achieving
  EARa Supplement EARa Supplement EARa
Vitamin D (µg) 10 15.1 ± 3.2 0 25.1 ± 3.2 0
Vitamin E (mg) 12 28.9 ± 3.3 0 46.9 ± 3.3 0
Iron (mg) 23 45.6 ± 9.9 0 54.6 ± 9.9 0
Calcium (mg) 1100 1086.2 ± 394.5 53 1086.2 ± 394.5 53
Magnesium (mg) 335 230.9 ± 83.1 90 270.9 ± 83.1 82

Abbreviation: EAR, estimated average requirements.

a
Estimated average requirements for pregnancy in those 14 to 18 years old.
b
Prenatal supplements contained 10 µg vitamin D3, 22 mg vitamin E, 27 mg Fe, 200 mg Ca, and 0 mg Mg.
c
Pediatric supplements contained 20 µg vitamin D3, 40 mg vitamin E, 36 mg Fe, 200 mg Ca, and 40 mg Mg.

very preterm delivery (<33 weeks’
gestation), a 2-fold reduced risk of LBW,
and a 6- to 7-fold reduction in the rate of
very LBW (<1500 g) among supplement
users.17 Although prenatal supplements
are routinely prescribed to adolescents,
compliance with prenatal
supplementation in adolescents is often
poor, based on reports from clinicians
working with this group. Stang et al18
pointed out that adolescents who may
benefit most from supplement use may
be less compliant when compared with
adolescents consuming more optimal
diets. Further studies identifying potential
barriers to prenatal supplement use as
well as additional data on the
knowledge, attitudes, and beliefs that
affect supplement use in pregnant
adolescents are needed to inform
effective behavior-change strategies.
Mean dietary intake did not change
significantly across pregnancy, which is
consistent with previous data in pregnant
adolescents and women, which found no
significant difference in the mean
nutrient intakes between the second and

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 ICAN: Infant, Child, & Adolescent Nutrition June 2014
third trimesters.19 This implies that early
dietary assessment in this population
may aid appropriate targeting and
interventions to modify intakes of
nutrients of concern. Adolescents often
lack nutrition knowledge and
understanding of how nutritional
demands are affected by pregnancy, and
they may lack resources on how to find
this information. Even among those who
are aware of good nutritional choices,
behaviors may be influenced by other
factors, such as hunger, food cravings,
taste, convenience, food availability, and
parental and cultural influences.
Nevertheless, pregnancy can be an
optimal time for teens to build nutrition
knowledge and implement behavioral
changes in support of the healthy
development of their baby, which may in
turn act as a positive reinforcement for
their dietary changes.20
Assessing pregnant teens at nutritional
risk and building individualized strategies
to meet dietary needs has previously
been a successful strategy to reduce
adverse outcomes of adolescent
pregnancy. In a group of 1203 pregnant
adolescents, individualized nutrition
interventions based on risk profiles were
shown to be effective in improving infant
birth weight and lowering the rate of
LBW.21 Many prenatal programs and
clinics are staffed with social workers
and nutritionists who are able to perform
early screening for risk factors that may
affect dietary intakes and birth outcomes.
Identifying these risk factors early in
pregnancy and designing individualized
strategies to overcome the major
obstacles identified should be
emphasized.
Limitations of this study include the
limited generalizability of these findings
because participants were a regional
convenience sample. However, nutrients
that were found to fall below the DRI in
this study were also noted in previous
studies among both pregnant (13-20
years old)22 and nonpregnant adolescents
(12-19 years old)23 and women.24
Under- and overreporting are sources of
bias in diet recalls because individuals
are more likely to underreport foods that
may be perceived as “unhealthy,”
158
whereas foods that are perceived as
“healthy” may be overreported.
Nevertheless, the limited time of the
prenatal appointment and the burden of
filling out multiple questionnaires made
the diet recall a suitable assessment tool
for this study. All dietary recalls were
conducted by the same individual and
analyzed by the same dietitian to
minimize potential bias.
In conclusion, a large proportion of
pregnant adolescents failed to achieve
the recommendations for several key
nutrients from diet alone. Early dietary
assessment may allow identification and
targeting of nutritional deficits and
excesses of concern. Nutritional
counseling should include education and
interventions to improve diet along with
strategies to enhance supplement
compliance. In light of the growing
evidence linking suboptimal intakes of
many nutrients with undesirable birth
outcomes, greater attention to the unique
dietary needs and intake patterns of this
vulnerable age group is warranted.
Acknowledgments
The authors thank Allison McIntyre (Health Project
Coordinator) for help in recruiting study participants
and administering questionnaires and Dr Patricia
Stewart and Robin Peck for assistance in analyzing
24-hour recall data; they also acknowledge support
from the University of Rochester Clinical and
Translational Science Institute. This study was
supported by the USDA [2005-35200-15218],
[2008-01857-05171], and in part, by UL1 RR
024160 from the National Center for Research
Resources (NCRR), a component of the National
Institutes of Health (NIH), and NIH Roadmap for
Medical Research. Its contents are solely the
responsibility of the authors and do not necessarily
represent the official view of NCRR or NIH.
Author Note
The author(s) declared no potential conflicts of
interest with respect to the research, authorship, and/
or publication of this article.
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